The Brief

For customers using a telehealth website to get cheaper versions of popular obesity drugs, the low prices turned out to be too good to be true.

Customers of Zappy Health tell NPR they were drawn to the online provider by its low prices, its lack of subscription fees and its handy smartphone app with a chat feature for patients to talk to one another during their weight-loss journeys.

The Zappy chat was ultimately how many customers first learned that Ousia Pharmacy — one of several pharmacies that supplied Zappy with compounded obesity drugs — didn't have a required license, one that ensured the drugs were produced in accordance with safety and potency standards.

Compounded drugs that Zappy and other telehealth sites sell aren't generics. Instead, they're essentially copies of the name-brand drugs, made by specialized pharmacies. The Food and Drug Administration allows this kind of compounding during drug shortages.

Compounding pharmacies are regulated at the state level. Ousia, in Spring Hill, Fla., didn't have what's called a sterile compounding license. The obesity drugs made by compounding pharmacies are given by injection, so attention to sterile production is critical to avoid contamination that could cause infections.

Zappy didn't find out about Ousia's licensing problem until December and it ceased its roughly three-month relationship with the pharmacy on Dec. 13, Zappy's founder, Dr. Michel Choueiri, told NPR in an email after a broadcast version of this story aired. He called Zappy "the biggest victims of this situation" and said that it has left the company in "severe financial and reputational ruin."

Some Zappy customers NPR spoke with found out about the problem on Reddit.

Laura Franzese, in Portland, Ore., learned about the licensing problem after spending $1,000 on a bulk order of tirzepatide from Zappy that arrived with Ousia labels. (Tirzepatide is the active ingredient in Eli Lilly's obesity drug Zepbound.) She'd been taking the drugs already, from a local provider, and called them "life-changing," but made the switch to Zappy hoping to save money.

"I bought three months' worth of medicine from this company," she says. Now she's afraid to use the drugs. "It was a big investment."

People active on Reddit told NPR that Zappy deleted the original user post in its app chat forum about Ousia's lack of the proper license. Choueiri says Zappy publicly apologized in the same forum and removed the post only while it was verifying the claim.

Ousia couldn't be reached for comment.

When Laura Franzese started with compounded tirzepatide at a local medical spa, she lost 20 pounds in 16 weeks. "It's giving me something that my body clearly needed," she says. But it was expensive. She discovered she could get a lower price from Zappy Health.

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Laura Franzese

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For many people who've turned to online telehealth companies to find compounded obesity drugs, they say they would prefer to take the brand-name drugs, but it isn't an option for them. They say Novo Nordisk's Wegovy and Eli Lilly's Zepbound aren't covered by their insurance. And paying the full sticker price — more than $1,000 a month — is too expensive.

Compounding pharmacies fill a gap for patients like this. They've been a part of the health care landscape for decades, preparing custom medicines for people who need them, but booming demand for weight-loss drugs — as well as resulting brand-name shortages — has brought them into new prominence.

Even some people who have health insurance coverage for obesity drugs say they turn to telehealth and compounding because they couldn't reliably find the brand-name drugs in local pharmacies.

But the situation with Ousia shows the pitfalls of navigating the world of online compounded obesity drugs, which includes legitimate businesses as well as some unlicensed or unregistered ones. It can be difficult for consumers to tell the difference or trust the quality of the obesity drugs they're buying.

Looking for a deal, finding confusion

For Zappy customers, the problems came as a surprise.

Eric Bishop, an IT professional in Salt Lake City, was looking for a way to buy more tirzepatide at once, fearing that the official end to the Zepbound shortage would mean the end of the compounded version. He had been filling his prescription at a local brick-and-mortar compounding pharmacy but turned to Zappy to buy a stockpile.

He didn't know which pharmacy would be fulfilling the order through Zappy until after he paid. "They didn't give me a choice," he says.

Bishop had just gotten his nine-month supply of tirzepatide, worth $2,700, from Zappy when users on the Zappy app blew the whistle on Ousia.

"That's when I started seeing things in the chat," he says of the app's patient forum feature. "So I bounced over to Reddit."

According to a complaint filed by the Florida Department of Health on Dec. 5, Ousia applied for a sterile compounding license in March 2024, but it was never granted. When state regulators inspected the facility later that year in August, they discovered that it was compounding medicines anyway. In addition, inspectors noted that Ousia was improperly storing drugs that needed to be refrigerated and not keeping proper records for drugs it dispensed.

The Florida Department of Health did not respond to requests for comment on this story. In an email to NPR, Zappy's founder, Choueiri, said the department failed to disclose Ousia's problem "in a timely manner."

Bishop couldn't believe what he was reading.

"I'm all of a sudden, you know, about ready to start taking my medication and I'm like, I now no longer have any confidence in what I have," Bishop says. "And I might either want my money back or I want a replacement for what I have."

Eric Bishop helps run a Facebook group for people who got Ousia vials from Zappy Health and are trying to get their money back. Since Ousia gave up its regular pharmacy license on Jan. 31, he says, some people have been more successful.

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Courtesy Eric Bishop

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Another Zappy patient, Nicole Drong, in Minneapolis, says she was surprised when vials marked "Ousia" arrived at her home. "I did not know the name of the pharmacy until I got a package. And I was like, 'Well, that's weird. I thought it was going to say 'Zappy' on it.'"

Then in December, she noticed the Zappy app was sending her a lot more notifications than usual from the patient forum. Word was out that Ousia didn't have a sterile compounding license.

"I kind of feel stupid, I guess," Drong says. She says she was " just blindly putting trust in this pharmacy. … How often do you ever have to double-check your medication? Like, if I go get my antidepressants from Walgreens, do I have to double-check to make sure there's not anything extra in my bottle of pills?"

Choueiri, Zappy's founder, says patients have the opportunity to cancel once they learn which pharmacy is fulfilling their order, and it has responded to patient feedback to be more transparent with customers up front.

Confusion and no refunds

The bureaucratic details of licensing can be opaque to consumers. But these licenses matter, says Scott Brunner, who leads the trade group of compounding pharmacists, the Alliance for Pharmacy Compounding. Ousia pharmacy wasn't a member, he says.

He called not having a sterile compounding license where one is required "egregious."

"I would not take a drug that has been dispensed to that patient from a pharmacy that has been found to be in violation of its state license law," he says.

Choueiri did a TikTok live on Jan. 15, where he said Zappy was "made aware of the complaint" and wanted to let the process play out. He added that his family members were taking the Ousia medications too and that he was also fielding questions from them.

"It's not counterfeit?" he said, reading questions as they came in. "Yeah, no. No, it's not counterfeit. Um no, no. The short answer is no, but I'm not going to go down the legal litigation here."

At first, Zappy told people they could fill out a Google form to get a refund or replacement vials, but customers tell NPR that nothing has come of it yet. For a time, Zappy also told customers to ask Ousia for a refund instead.

On Jan. 31, 2025, Ousia voluntarily relinquished its regular pharmacy license, Florida records show. Now, the pharmacy's phone number goes to voicemail and its website is down.

Asked what Zappy is now advising its patients to do with their Ousia vials, Choueiri wrote to NPR: "As always, Zappy is a platform that connects patients to affordable care but does not replace the role of medical providers or pharmacists. Decisions about medication use should always be made in consultation with a licensed healthcare professional, and defer these conversations to the providers of care."

Zappy Health ads on Facebook and Instagram promote its weight-loss program, which involves connecting patients to online providers and sending them low-cost obesity drugs made by compounding pharmacies.

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Zappy/Images screenshot and compiled by NPR

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Choueiri is a medical doctor. On its website, Zappy touts that its weight-loss plans "are personalized by doctors."

According to Zappy's terms of service, the doctor-patient relationship isn't between Zappy and its users. It's between the providers who do virtual appointments and prescribing on Zappy and the Zappy customers. And the company "disclaims any liability for the medical or pharmaceutical services provided through its platform."

Spotting red flags

While the Ousia situation is unfortunate for the patients involved, it's an example of the regulatory system working the way it's supposed to, says Brunner.

The National Association of Boards of Pharmacy says it's hard to know how many online retailers are offering compounded obesity drugs that are made without the proper license or registration. State pharmacy boards oversee most compounding pharmacies around the U.S., but if a pharmacy isn't registered or licensed in a state where it's shipping products, it can be hard to track.

Betty Jones, compliance senior manager of the accreditation and inspection programs at NABP, says consumers can protect themselves by looking out for red flags. For instance, you should always know which pharmacy is filling your prescription, and they're required to provide counseling.

"If they're not providing you that offer of patient counseling or you're calling into that pharmacy and they don't allow you to, you know, be progressed to a pharmacist where you can ask questions, that would be something that I would call a red flag."

She says prices that are too low and pharmacies that don't ask for a prescription should also trigger alarm bells.

Potential customers should also be able to verify that a pharmacy is licensed, since these are public records available online in most states. And to dispense to you, that means the pharmacy needs to be licensed in your state, too — not just the one where it's located.

Bishop, the Zappy customer in Salt Lake City, says he helped organize a Facebook group for people to help them figure out how to get their money back. Customers say they haven't been able to get refunds.

Choueiri says Zappy's low prices mean it doesn't have much money left over after paying pharmacies and providers, and "Zappy does not control the funds necessary to issue refunds."

The Facebook group has grown to more than 600 people. Its members have even helped report new information to the Florida Department of Health, Bishop says. "We're just a community just kind of helping each other out."

Many of the group members' banks initially declined to reverse their credit card transactions with Zappy. That has started to change since Ousia relinquished its license, Bishop says. "Actually, some banks are even opening disputes that they closed previously."

Zappy is still advertising to customers, but Bishop says he isn't buying from the company again. He's back on compounded tirzepatide from his local pharmacy.
Copyright 2025 NPR

Gov. Gavin Newsom has signed a bill aimed at protecting children who are abused.

The law, which went into effect this week, is named “Gabriel’s Law,” after Gabriel Fernandez — an 8-year-old boy in Palmdale who died in 2013 after being tortured and abused by his mother and her boyfriend.

“It devastated the community. Still has,” said State Assemblymember Tom Lackey (R-Palmdale), who worked on legislation related to Gabriel’s case for years. “It hasn't gone away, right? It’s something we still acknowledge.”

Since Fernandez’s death, the Antelope Valley has seen a number of high-profile child deaths at the hands of their parents.

The new law requires social workers to make sure a child gets emergency medical care when needed, and it makes it easier to prosecute social workers who knowingly falsify records.

Officials said there had been warning signs about Fernandez’s abuse, but social workers with the L.A. County Department of Children and Family Services failed to follow up on them. The high-profile case prompted internal reforms in the agency.

What happened to Gabriel

Gabriel died in May 2013, after months of abuse from his mother and her boyfriend. He was found with a number of injuries, including a fractured skull, broken ribs and BB pellets lodged in his body. His mother and her boyfriend were both sentenced.

A teacher had reported signs of abuse to the county, but social workers did not remove him from the home. Then they ended the investigation. Prosecutors charged the social workers with child abuse, but the charges were later dismissed.

“He was literally tortured. And there were many, many, many documented events, and there are many encounters that he had with people that lacked follow-up,” Lackey said.

What does the law change?

Before this week, the law said that social workers may authorize care if a child needs immediate emergency care, but did not require it. Gabriel’s law requires a social worker to secure medical care for a child.

“ They call for an ambulance or escort the child to an emergency room— make sure a physician has the opportunity to provide some level of remedy and documentation of the injury,” Lackey said.

It also clarifies the law so that social workers who are guilty of falsifying or destroying public records can be imprisoned or fined.

Why did the law take so long to change?

Lackey’s previous legislative efforts related to Fernandez’s case failed over the years. He introduced at least five different pieces of legislation that failed to advance.

“I'm not even saying that I blame the pushback and the concern, because if you're too aggressive, there's a tendency to accuse people of wrongdoing when they are not guilty of wrongdoing, so we wanted to make sure that the balance was reasonable,” he said.

Lackey terms out this year. “We're trying to do something as a community to not only pay tribute to [Gabriel], but to prevent it from reoccurring,” he said.

A series of community listening sessions will give residents a chance to weigh in on whether streets, monuments and public parks bearing the name of former labor leader César Chávez should be renamed. 

The sessions, scheduled for October and led by the Los Angeles County Chief Executive Office, come after the county launched a survey in June asking the public what mattered most to them in a renaming process.

In March, the Board of Supervisors approved a motion, authored by Supervisors Hilda Solis and Lindsey Horvath, to rename county honors following a New York Times investigation that alleged Chávez sexually assaulted women and girls within the United Farm Workers movement, including fellow labor leader Dolores Huerta.

“The County of Los Angeles has a firm responsibility to ensure any public recognitions reflect our shared values of justice, dignity, and respect,” Solis said in a statement at the time.

Following the investigation, some Eastside residents called for Cesar E. Chavez Avenue to revert to its former name, Brooklyn Avenue, and for murals depicting Chávez’s face to be taken down.

The board also approved a motion by Solis to rename the César Chávez holiday as Farmworkers Day across the county, which will continue to be observed on the last Monday in March instead of Chávez’s birthday on March 31.

How to weigh in

Three in-person community listening sessions will be held in East LA in October. Online registration is encouraged but not required. To register, click here.

Saturday, Oct. 10 – Anthony Quinn Library

Time: 10 a.m. to 12:30 p.m.

Location: 3965 E. Cesar E. Chavez Ave., Los Angeles

Saturday, Oct. 17 – Ruben F. Salazar Park

Time: 10 a.m. to 12:30 p.m.

Location: 3864 Whittier Blvd., Los Angeles

Note: This session will be held in Spanish only 

Saturday, Oct. 24 – East LA Service Center

Time: 10 a.m. to 12:30 p.m.

Location: 133 N. Sunol Dr., Los Angeles

*Spanish-language interpretation will be available

The post LA County wants your input on renaming Cesar E. Chavez Avenue. Join these meetings to weigh in appeared first on LA Local.

Republican State Assemblyman Carl DeMaio is seeking to distance the voter ID measure Californians will see on their November ballot from President Donald Trump’s efforts to restrict voting at the federal level. During a Monday night speech at the Orange County GOP Central Committee meeting, DeMaio said the ballot measure, Proposition 39, is “not the same” as the failed federal SAVE Act, which would have required proof of U.S. citizenship when registering to vote.

Speaking to dozens of O.C. Republican leaders, DeMaio acknowledged Californians’ overwhelming embrace of mail-in voting, calling Prop. 39 a “bipartisan solution that keeps mail ballots, so that voting is convenient, but improves trust and confidence by requiring an ID to vote.”

What would Prop. 39 do?

• Prop. 39 would change California’s constitution to require voters to provide a government-issued ID when they cast a ballot.
• Mail-in voters would have to include the last four digits of that ID on the ballot envelope.
• The measure would also require election officials to use “best efforts,” using government data, to verify that voters on registration rolls are U.S. citizens, and to report annually the percentage verified.

Reaction to the ballot initiative

Supporters note that nationwide polling has shown widespread support for voter ID across political parties. They also say using a voter’s signature on their mail-in ballot to verify identity, as California currently does, delays election results and causes some valid voters to have their ballots rejected.

Opponents of Prop. 39 say the initiative feeds into President Trump’s claims of widespread election fraud, which they say are false. Opponents also say the measure would make voting more burdensome and expensive, while opening up mail voters to potential identity theft.

How Prop. 39 is being pitched to voters

The latest polling on Prop. 39 suggests it could face an uphill battle in November.

Registered Republicans make up only about one-quarter of California’s electorate, which means Prop. 39 will need significant support from Democrats and independent voters to pass.

A recent poll from the Public Policy Institute of California found a sharp partisan divide in interest in Prop. 39, with a majority (52%) of Republican voters saying it was the ballot measure that most interested them compared to just 7% of Democrats and 23% of independent voters.

In an effort to appeal to the state’s liberal majority, DeMaio and his Reform California PAC recently launched an ad campaign aimed at persuading Trump foes that Prop 39 is unrelated to the president’s efforts to curb mail-in voting and implement stringent checks for U.S. citizenship.

“Can you dislike Trump and still vote ‘yes’ on Prop 39 for voter ID?” a voice in the ad asks. “Yes, you can.”

During his speech Monday, DeMaio said Prop. 39 would boost confidence in elections “whether you think voter fraud is a big problem or a small problem.”

In a subsequent interview with LAist, DeMaio said he thinks voter fraud is a problem. “ How much fraud is hard to prove because we're not looking for it; we don't have internal controls,” he said.

Trump has claimed that large numbers of noncitizens are voting. In California, a handful of recent cases have made headlines. But nationwide efforts to find and prosecute noncitizen voters have thus far turned up few culprits.

The Texas example

Julia Gomez, a senior staff attorney with the ACLU of Southern California, which opposes Prop. 39, blamed the decrease in voter confidence on the “chaos” sowed by people including Trump and DeMaio in questioning the integrity of elections with scant evidence of fraud.

“The way we build trust in elections is not by adding more hurdles to voting, which the data shows will disenfranchise voters every election, but by educating voters, by not lying to voters about what is and isn't a problem,” she said.

Gomez pointed to Texas as a cautionary tale about the potential consequences of adding an ID requirement to mail-in voting: After Texas passed a similar requirement in 2021, a large percentage (14%) of mail-in ballots were rejected, according to a study last year from the Brennan Center for Justice at New York University School of Law.

The study found that non-white voters were more likely to have their ballots rejected. Also, many of those voters stopped casting ballots in subsequent elections.